Search

Elevated body mass index is a risk factor for gallstone disease and cholecystectomy, but outcomes for low body mass index patients remain uncharacterized. We examined the association of body mass index with morbidity, mortality, and resource use after cholecystectomy.The 2005 to 2016 American College of Surgeons National Surgical Quality Improvement Program was retrospectively analyzed for adult patients undergoing laparoscopic and open cholecystectomy. Patients were stratified into 5 groups: body mass index18.5 (underweight), body mass index 18.5 to 24.9 (normal weight), body mass index 25 to 29.9 (overweight), body mass index 30 to 34.9 (class I obesity), body mass index 35 to 39.9 (class II obesity), and body mass index ≥40 (class III obesity). Multivariable regressions identified independent associations of covariates with 30-day mortality, complications, and resource use.Of 327,473 cholecystectomy patients, 1.0% were underweight, 19.5% normal weight, 30.3% overweight, 24.0% class I obesity, 13.5% class II obesity, and 11.7% class III obesity. After multivariable analysis, underweight patients had a higher risk of mortality (adjusted odds ratio = 1.53; P = .029) and postoperative bleeding (adjusted odds ratio = 1.45; P = .011) relative to normal weight patients. Conversely, class III obesity patients had lower mortality (adjusted odds ratio = 0.66; P = .005) but increased operative time (β = 10.2 minutes; P.001), wound infection (adjusted odds ratio = 1.38; P.001), and wound dehiscence (adjusted odds ratio = 2.20; P.001). Hospital duration of stay and readmission rates were highest for underweight patients.Underweight patients experience increased risk of mortality and readmission, while class III obesity patients have higher rates of wound infection and dehiscence as well as prolonged operative time. These findings may guide choice of intervention.

Background Childhood obesity increases the risk of non-alcoholic fatty liver disease marked by elevated alanine aminotransferase (ALT). This study investigated the prevalence of increased ALT in children and adolescents with obesity, and its associations with sex, age, degree of obesity, and metabolic parameters. Methods Individuals between 5 and 17.99 years of age enrolled in the Swedish Childhood Obesity Treatment Register (BORIS) before March 2020 were included. Mildly increased ALT was defined by ALT 27–51 U/L (males) and 23–43 U/L (females), while markedly increased ALT by levels above. Multiple logistic regression models were used for statistical analysis. Results Among 11,776 individuals (age 11.0 ± 3.3 years, 53.5% males), the prevalence of mildly and markedly increased ALT were 37.9 and 10.6%, respectively. A sex-age interaction was found, where increasing age strengthened the odds of markedly increased ALT in males (OR, 99% CI: 1.34, 1.29–1.4 for each year) while the corresponding pattern in females with was minuscule (1.09, 1.02–1.10). Compared to class I obesity, class II and III obesity had greater odds ratios for mildly increased ALT (class II obesity OR, 99% CI: 1.51, 1.35–1.70; class III obesity OR, 99% CI: 2.17, 1.66–2.61) and for markedly increased ALT (class II obesity OR, 99% CI: 1.82, 1.51–2.20; class III obesity OR, 99% CI 3.38, 2.71–4.23). Dyslipidemia was associated with both mildly and markedly increased ALT, all p Conclusions The risk of markedly increased ALT increased exponentially with age among boys, but not among girls. Higher degree of obesity was observed in individuals with mildly and markedly increased ALT. Further, metabolic derangements were more prevalent among individuals with mildly and markedly increased ALT.

Background Class II obesity (body mass index BMI ≥35 kg/m2) is a contraindication to heart transplantation (HT). Although few single-center studies (case reports/series and small cohorts) have reported promising outcomes of bariatric surgery (BS) in patients with obesity and ventricular assist devices, low sample sizes have made their analysis and interpretation challenging. Methods and Results We conducted a systematic search in ClinicalTrials.gov, Cochrane, Embase, PubMed, Google Scholar, and most relevant bariatric and heart failure journals. We extracted baseline and outcome individual participant data for every ventricular assist device patient undergoing BS with reported postoperative BMI and their respective timepoints when BMI data were measured. Fourteen references with 29 patients were included. The mean age was 41.9 ± 12.2 years, 82.8% underwent laparoscopic sleeve gastrectomy, and 39.3% had reported perioperative adverse events. The mean pre-BS BMI was 45.5 ± 6.6 kg/m2 and decreased significantly during follow-up (rho –0.671; P Conclusions BS may help patients with obesity and ventricular assist devices to lose a significant amount of weight and improve their candidacy for HT or even achieve myocardial recovery.

Backgraund: obesity/overweight in women are often the causes of menstrual dysfunction and infertility.Aims: To identify the association between overweight/obesity and IVF outcomes.Materials and methods: retrospective study — data of 1874 patients undergoing IVF in the Endocrinology Research Centre (2012–2019) was analyzed. Exclusion criteria: BMI Results: Patients were divided into 5 groups (gr.): normal body weight (NBW) - 1061 people (ppl.) (gr. 1), overweight — 368 (gr. 2), class I obesity — 117 (gr. 3), class II obesity — 36 (gr. 4), class III obesity — 1 (gr. 5). In each group, the estimated pregnancy rate (PR) and its outcomes, the frequency of lightweight newborns (body weight at birth Conclusions: Correlation analysis of the dependence of PR and its outcomes on the BMI was not revealed (p=0.975 and p=0.469, respectively). Large fetus births were more often detected in obese patients (p=0.0016). A large prospective group is needed to expand the estimated body parameters to the IVF outcomes.

Objective In patients with endometrial cancer, obesity is associated with favorable prognostic characteristics but not with prolonged survival. The aim of this study was to elucidate the reason for this clinical paradox. Methods We retrospectively reviewed 1173 patients with endometrial cancer. Patients were divided into a non-obese group [body mass index (BMI) Results Three disease-intrinsic variables—older age, advanced stage and high-risk histology—and three treatment-related variables—no hysterectomy, no lymphadenectomy and no chemotherapy—were independently associated with poor DSS. DSS was similar among the three groups of patients even though the proportion of patients with plural pretreatment-related unfavorable risk factors significantly decreased with increment of BMI category (40.1 vs. 27.5 vs. 17.6%, P = 0.0003). The proportion of patients with plural treatment-related unfavorable prognostic factors significantly increased with increment of BMI category (21.3 vs. 26.7 vs. 39.3%, P = 0.0072). Conclusions Poor-quality surgical staging in obese women may result in worse than expected survival outcomes.

Objectives: In obesity, there is a shift in the pro-oxidative-antioxidant balance towards the oxidationreactions. However, it has been shown that in people with normal body composition, after a series of whole-body cryotherapy (WBC), the balance shifts in the opposite direction. Design: The aim of the study was to assess the impact of 20 WBC treatments on blood pro-oxidative-antioxidant balance. Interventions: Study included 14 obese (BMI > 35) and 10 non-obese volunteers. Methods: The total antioxidative (TAS/TAC) and pro-oxidative status (TOS/TOC) in serum and activity of antioxidant enzymes in erythrocytes were determined before the first and 2 hours after the last cryostimulation. Results: In the obese group, a significantly higher level of TOS/TOC, and its significant decrease after the WBC series, was observed. Cryotherapy had no influence on TAS/TAC level which was similar in both groups. Changes in activity of antioxidant enzymes were multidirectional. An increase in CAT activity in the obese group was observed. OSI, both before and after a series of treatments, was significantly higher in obese subjects. Conclusions: A beneficial effect on the level of TOS/TOC and CAT activity was indicated, but the proposed number of treatments for patients with class II obesity turned out to be insufficient. Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12619000524190.

OBJECTIVE The aim: To study the peculiarities of CD68+ and CD163+ macrophage expression in the placentas of women with obesity who developed preeclampsia by applying immunohistochemical method. PATIENTS AND METHODS Materials and methods: The study included 20 placentas taken from women who delivered full-term live-birth babies. The women were divided into 4 groups of 5 individuals each: women with physiological body weight (1st group); women with class II obesity (2nd group); women with physiological body weight and preeclampsia (3rd group); women with class II obesity, who developed preeclampsia (4th group). RESULTS Results: The analysis of the expression level of CD68+ and CD163+ decidual macrophages shows the predominance of CD68+ pro-inflammatory profile over CD163+ anti-inflammatory profile in women of all groups. Evaluation of CD68+ and CD163+ expression levels of Kashchenko-Hofbauer cells in the stroma of the terminal villi of the placentashows that the expression level of CD68+ macrophages is significantly higher in women with obesity and preeclampsia than in the control, or in women with obesity or preeclampsia. There was a reverse tendency to the polarization shift in Kashchenko-Hoffbauer cells in the stroma of the terminal villi towards the predominance of CD163+ macrophages over CD68+ macrophages in all groups of women. CONCLUSION Conclusions: The imbalance in anti-inflammatory and pro-inflammatory profile of placental macrophages with a predominance of the latter can lead to the development of preeclampsia.

OBJECTIVE The aim: To determine the influence of obesity on cutaneous microcirculation in patients with different stages of obesity and without cardio-vascular pathologies. PATIENTS AND METHODS Materials and methods: The 67 eligible patients with obesity were enrolled into the main group in this research. 20 healthy patients with normal body weight were included in the control group in this study. The mean age and gender were similar among the groups. Each patient underwent a clinical evaluation during the consultation, biological tests, electrocardiogram, Laser Doppler flowmetry. RESULTS Results: There was a significant decrease in IM and σ in patients with class II obesity and class III obesity compared with control group. IV was decreased in all groups, but the significant differences were recorded only among patients with obesity and not among overweight patients. During wavelet analysis a significant decrease of the AmaxE was detected in all 4 groups (by 14,7%, 37,7%, 52,4%, 57,4% respectively, P < 0,05). The most significant changes were recorded in the heart spectrum (AmaxC). CONCLUSION Conclusions: Overweight patients and patients with obesity without cardio-vascular pathology have initial manifestations of microcirculatory disorders, which deteriorate with an increase of BMI. Changes in microcirculation in patients with obesity characterized by the significant decrease of microvessels perfusion, decreasing endothelial and increasing heart specter modulations. Only high BMI was found to be associated with impaired microcirculation endothelial function (AmaxE B=0.446, 95% CI [0,15, 0,92]) according to the results of regression analysis.

Background : COVID-19, caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), emerged as a global pandemic with confirmed death cases of more than 1.27 million worldwide. Since the past pandemic, several studies discovered the adverse effects of excess fat accumulation on the severity of viral infections. This study aimed to investigate the association between high body mass index (BMI) and mortality risk in hospitalized COVID-19 patients based on four categories of high BMI ranges. Subjects and Method : A systematic review and Meta-Analysis was conducted using search articles from electronic databases including PubMed, Google Scholar, and Scopus, published from 2019 to 2021. The keywords used to retrieve articles were "Body Mass Index" OR BMI OR Obesity OR Overweight) AND (Mortality OR Death) AND COVID-19 OR SARS-CoV-2. The included studies were full-text articles published in the English language, reporting adjusted odds ratios from multivariate analysis. The eligibility criteria were defined using PICO model. The article selection was conducted using PRISMA flow chart. The included studies were analyzed by the Review Manager 5.3 application. Results : A total of nine cohort studies involving 12,907 COVID-19 patients with high BMI conducted from America, Europe, and Georgia regions was included in qualitative synthesis and Meta-Analysis. The pooled estimate showed hospitalized COVID-19 patients with morbid/ class III obesity had a higher risk of mortality (aOR= 1.77; 95% CI= 1.27 to 2.47; p= 0.001) than overweight (aOR= 1.10; 95% CI= 1.00 to 1.21; p= 0.060), class I (aOR= 1.16; 95% CI= 0.87 to 1.55; p= 0.300), and class II obesity (aOR= 1.54; 95% CI= 1.11 to 2.13; p= 0.009). Conclusion : High BMI increases the risk of mortality in hospitalized COVID-19 patients. A potential dose-response relationship may exist between different categories of high BMI range and mortality risk in COVID-19 patients. Keywords : BMI, obesity, mortality, COVID-19, SARS-CoV-2 Correspondence : Yuzana Maung. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: yuzmg5699@gmail.com. Mobile: +6281295346614. Journal of Epidemiology and Public Health (2021), 06(01) https://doi.org/10.26911/jepublichealth.2021.06.01.08

OBJECTIVE: The aim of this study was to identify longitudinal trajectories of conjoint development of executive function (EF) and obesity among a diverse sample of poor, rural youth and to evaluate individual differences in infant growth, parental BMI, and cumulative risk. METHODS: Participants included 948 youth from the Family Life Project. Child anthropometrics were measured at 2 and 6 months and at 2, 3, 4, 5, 7, and 12 years. EF tasks were administered at 3, 4, and 5 years. Mothers reported youth birth weight, parental height and weight, and cumulative risk indicators. RESULTS: Multidimensional growth mixture modeling identified three classes: “High EF – High Obesity Resilience”; “Low EF – Delayed-Onset Severe Obesity”; and “Low EF – Early-Onset Severe Obesity.” Youth in the low-EF, early-onset class displayed higher birth weight and BMI at 6 months, whereas the low-EF, delayed-onset class had rapid weight gain during infancy, parents with class II obesity, and greater cumulative risk and was more likely to be Black and female. CONCLUSIONS: Despite increased obesity risk among this sample, the majority of youth exhibited higher EF and some degree of obesity resilience. Youth with EF deficits displayed the greatest risk for severe obesity but had differing BMI trajectories and obesity risk profiles, which has implications for obesity intervention.

BACKGROUND: Asian Americans are among the fastest growing subpopulations in the United States. However, evidence about maternal prepregnancy body mass index (BMI) and preterm birth among Asian Americans is lacking. METHODS: This population-based study used nationwide birth certificate data from the US National Vital Statistics System 2014 to 2018. All Asian American mothers who had a singleton live birth were included. According to Asian-specific cutoffs, maternal prepregnancy BMI was classified into underweight (BMI < 18.5 kg/m(2)), normal weight (BMI 18.5–22.9 kg/m(2)), overweight (BMI 23.0–27.4 kg/m(2)), class I obesity (BMI 27.5–32.4 kg/m(2)), class II obesity (BMI 32.5–37.4 kg/m(2)), and class III obesity (BMI ≥37.5 kg/m(2)). Preterm birth was defined as gestational age less than 37 weeks. Multivariable logistic regression models were used to estimate the odds ratio (OR) of preterm birth. RESULTS: We included 1 081 341 Asian American mother-infant pairs. The rate of preterm birth was 6.51% (n = 70 434). The rate of maternal prepregnancy overweight and obesity was 46.80% (n = 506 042). Compared with mothers with normal weight, the adjusted OR of preterm delivery was 1.04 (95% CI, 1.01–1.07) for underweight mothers, 1.18 (95% CI, 1.16–1.20) for overweight mothers, 1.41 (95% CI, 1.37–1.44) for mothers with class I obesity, 1.69 (95% CI, 1.63–1.76) for mothers with class II obesity, and 1.78 (95% CI, 1.66–1.90) for mothers with class III obesity. Similar patterns of associations were observed in Asian American mothers across different country origins. CONCLUSIONS: Among Asian American mothers, maternal prepregnancy overweight or obesity, defined by Asian-specific, lower BMI cutoffs, was significantly associated with an increased risk of preterm birth. The risk of preterm birth increased with increasing obesity severity. These findings highlight the importance of using Asian-specific BMI cutoffs in assessing risk of preterm birth among Asian American mothers.

Background Telomere length (TL) is one biomarker of cell aging used to explore the effects of the environment on age-related pathologies. Obesity and high body mass index have been identified as a risk factors for shortened TL. Objective To evaluate TL in different subtypes of obese patients, and to examine changes in TL in relation to weight loss after bariatric surgery. Setting University Hospital in Spain. Methods A cohort of 94 patients submitted to bariatric surgery were followed-up during 24 months (t24m: lost to follow-up = 0%). All patients were evaluated before surgery (t0) and during the postoperative period (t6m, t12m, and t24m) for body mass index and metabolic variables. We assessed TL at each timepoint using quantitative polymerase chain reactions and the telomere sequence to single-copy gene sequence ratio method. Results Patients with class III obesity showed significantly shorter TL at baseline than those patients with class II obesity (P = .027). No differences in TL were found between patients with or without type 2 diabetes or metabolic syndrome. Longitudinal analysis did not show an effect of time, type of surgery, age, or sex on TL. However, a generalized estimating equation model showed that TL was shorter amongst class III obesity patients across the time course (P = .008). Comparison between patients with obesity class II and class III showed differences in TL at t6m (adjusted P = .024), whereby class II patients had longer TL. However, no difference was observed at the other evaluated times. Conclusion Obesity severity may have negative effects on TL independently of type 2 diabetes or metabolic syndrome. Although TL is significantly longer in class II obesity patients relative to class III 6 months after bariatric surgery. This difference is not apparent after 24 months.

Aim: to examine intensity of surgical menopause symptoms (postovariectomy syndrome, POES) in patients with borderline ovarian tumors (BOTs) after radical surgery depending on the postoperative period management; to assess a role for “cancer immunotherapy diet”* as a standalone means in correction of surgical menopause symptoms as well as a part of patient-specific rehabilitation program.Materials and Methods. A prospective comparative study was conducted with 62 BOTs female patients aged 30 to 48 (42.0 ± 4.1) years underwent radical surgical treatment, subdivided into 3 groups: group I – “active” rehabilitation (29 subjects underwent 12 month-comprehensive personalized rehabilitation); group II – “passive” rehabilitation (17 women with standard management of the postoperative period in accordance with clinical recommendations); group III – 16 patients followed the one-year “cancer immunotherapy diet” (after being consulted by medical specialist and formulation of individual diet program). Patient data obtained after clinical interview, physical, laboratory and instrumental examinations were assessed at four time points: before surgery (visit 0), after 1, 6 and 12 months (visits 1, 2, 3) after antitumor treatment. In addition, every visit required each patient to fill out the modified Kupperman menopausal index (MMI) questionnaire specifically adapted for BOTs patients. Intensity of neurovegetative, psycho-emotional and metabolic manifestations of surgical menopause symptoms was assessed at various stages of post-surgery period and management strategy during post-surgery period.Results. All BOTs patients one month after radical surgical treatment noted overt signs of surgical menopause. Before surgery, the average MMI score corresponded to normal range – 10.9 (group I), 10.5 (group II), 10.4 (group III), whereas during visit 1 it changed to 37.1, 35.2 and 36.4, respectively evidencing about moderate severity of POES. MMI largely depended on management strategy 6 and 12 months after the onset of therapy: in “active” rehabilitation group it was 27.7 (visit 2) and 22.2 (visit 3), “passive” rehabilitation group – 39.1 (visit 2) and 42.6 (visit 3), “cancer immunotherapy diet” group – 34.1 (visit 2) and 30.8 (visit 3). In addition, distribution of patients based on body mass index (BMI) revealed various types of impaired fat metabolism (IFM) in 59.68 % subjects at visit 0, that increased one month after surgery up to 64.52 %, whereas 6 and 12 months later it decreased down to 62.90 and 61.29 %, respectively. However, end-point results in different groups varied substantially: In particular, at visit 3 in group I 55.17 % (n = 16) subjects had normal BMI, 37.93 % (n = 11) – class I obesity and 6.90 % (n = 2) – class II obesity. The end-point results in group II revealed no patients with normal BMI: 76.47 % (n = 13) and 23.53 % (n = 4) had class I and class II obesity, respectively. Finally, end-point results in group III were at intermediate state: 50.0 % (n = 8) subjects showed normal BMI, whereas 37.5 % (n = 6) and 12.5 % (n = 2) patients demonstrated class I and class II obesity, respectively.Conclusion. Adjuvant therapy of surgical menopause symptoms represents an important component in rehabilitation program for BOTs patients underwent radical surgery. A personalized rehabilitation program demonstrates peak efficacy in correcting surgical menopause symptoms (essential to include “cancer immunotherapy diet” therein). Even isolated administration of diet therapy profoundly reduces intensity of surgical menopause symptoms, thereby improving the quality of woman’s life.

We sought to quantify the severity and duration of hypoxemic events in morbidly obese patients during outpatient endoscopy procedures performed under deep sedation. This was a retrospective cohort study using intraprocedural pulse oximetry readings from 11,595 American Society of Anesthesiologists physical status score I–III adult patients who underwent deep sedation for elective endoscopy at free standing ambulatory centres between June 2015 and June 2016. Unadjusted and risk-adjusted logistic regression analyses explored the relationship between increasing categories of body mass index (BMI) and intraoperative hypoxemia, severe hypoxemia, and prolonged hypoxemia. Hypoxemia occurred in 600 (13%) patients with normal BMI, 314 (18%) with class I obesity, 159 (27%) with class II obesity, and 24 (19%) with class III obesity. Adjusted odds ratio (AOR) for any occurrence of intraoperative hypoxemia increased from 1.61 (95% confidence interval [CI], 1.35 to 1.90; P < 0.001) in the class I obesity group to 2.61 (95% CI, 2.05 to 3.30; P < 0.001) in patients with class II obesity, when compared with patients with normal BMI. Adjusted odds ratio of severe hypoxemia were significant in the class I obesity group (AOR, 1.47; 95% CI, 1.13 to 1.89; P = 0.003), and the class II obesity group (AOR, 2.59; 95% CI, 1.86 to 3.57; P < 0.001). Adjusted odds ratio of prolonged hypoxemia increased with each category of BMI from 1.97 (95% CI, 1.08 to 3.69) in the overweight group to 9.20 (95% CI, 4.74 to 18.03) in patients with class III obesity. The incidence of severe hypoxemia increased nearly six-fold in obese patients and 8.5-fold in class III obese patients when compared with those of normal BMI. Intravenous fentanyl was associated with intraoperative hypoxemia independent of BMI. Patients who represent the highest risk for hypoxia should be stratified to procedure locations with adequate resources for the safest care.

Objective: The apparent survival benefit of being overweight or obese in critically ill patients (the obesity paradox) remains controversial. Our aim is to report on the epidemiology and outcomes of obesity within a large heterogenous critically ill adult population. Design: Retrospective observational cohort study. Setting: Intensive care units (ICUs) in Australia and New Zealand. Participants: Critically ill patients who had both height and weight recorded between 2010 and 2018. Outcome measures: Hospital mortality in each of five body mass index (BMI) strata. Subgroups analysed included diagnostic category, gender, age, ventilation status and length of stay. Results: Data were available for 381 855 patients, 68% of whom were overweight or obese. Increasing level of obesity was associated with lower unadjusted hospital mortality: underweight (11.9%), normal weight (7.7%), overweight (6.4%), class I obesity (5.4%), and class II obesity (5.3%). After adjustment, mortality was lowest for patients with class I obesity (adjusted odds ratio, 0.78; 95% CI, 0.74- 0.82). Adverse outcomes with class II obesity were only seen in patients with cardiovascular and cardiac surgery ICU admission diagnoses, where mortality risk rose with progressively higher BMIs. Conclusion: We describe the epidemiology of obesity within a critically ill Australian and New Zealand population and confirm that some level of obesity is associated with lower mortality, both overall and across a range of diagnostic categories and important subgroups. Further research should focus on potential confounders such as nutritional status and the appropriateness of BMI in isolation as an anthropometric measure in critically ill patients.

Backgraund : obesity/overweight in women are often the causes of menstrual dysfunction and infertility. Aims : To identify the association between overweight/obesity and IVF outcomes. Materials and methods : retrospective study — data of 1874 patients undergoing IVF in the Endocrinology Research Centre (2012–2019) was analyzed. Exclusion criteria: BMI

Aim. To study creatinine clearance, body mass index and to perform ROSE survey amomg patients with hypertension of different age groups at territorial internist's area. Methods. The study involved 112 patients aged 40 to 75 years. Patients were divided into two groups according to the age: group 1 40 to 61 years, 55 people (15 men and 40 women), the average age 52.67.1 years; group 2 62 to 75 years, 57 people (15 men and 42 women), the average age 69.84.4 years. Creatinine clearance and body mass index were measured, and ROSE survey was conducted. Results. In group 1 creatinine clearance 60 ml/min was in 5 (9%) subjects, in group 2 in 20 (35%; p=0.002). In group 1 15 (27%) subjects had normal body mass, in group 2 5 (9%). In group 1 overweight was registered in 18 (33%) subjects, and in group 2 in 24 (42%; p=0.407). Class I obesity in group 1 was found in 15 (27%) patients, in group 2 in 16 (28%; p=0.907). Class II obesity in group 1 was noted in 5 (9%) patients, in group 2 in 4 (7%; p=0.955). Class III obesity in group 1 was registered in 2 (4%) people and in 8 (14%) in group 2 (p=0.110). According to the results of ROSE questionnaire, signs of angina pectoris were found in 7 (13%) patients in group 1 and 17 (30%) in group 2 (p=0.048). Conclusion. In the territorial internist's area the proportion of cases of overweight and obesity among patients of groups 1 and 2 with hypertension did not differ significantly (p 0.05); in patients from group 2 with hypertension creatinine clearance less than 60 ml/min was identified 3.9 times more often than in the younger age group (p=0.002); in patients of group 2 with hypertension were 2.3 times more likely to have angina, according to ROSE questionnaire than in group 1 (p=0.048).

Background Obesity is an in independent risk factor for cardiovascular disease. Goal To describe the early LV remodelling pattern in patients with overweight and obesity and structurally normal hearts. Methods Consecutive patients (n = 2374), with structurally normal hearts and BMI ≥ 18.5 kg/m2, undergoing prospective mid-diastolic ECG gated CTCA were selected. Left ventricular mass (LVM) and Left ventricular mid-diastolic volume (LVMDV) were measured. The concentricity index (LVM/LVMDV) were calculated. According to the definitions of the World Health Organization (WHO), the patients were divided into weight categories. Results The mean LVM ± Std. deviation in the subgroups according to WHO classification was 101.68 ± 28.99 g (normal weight), 115.79 ± 29.14 g (overweight), 123.8 ± 33.44 g (class I obesity), 125.85 ± 32.89 g (class II obesity) and 132.45 ± 37.85 g (class III obesity). (p The mean LVMDV progressed with increasing WHO weight category from 112.37 ± 36.46 in patients with normal BMI to 140.26 ± 43.78 in patients with class III obesity. (p The concentricity index was 0.935 ± 0.216 g/ml in patients with normal BMI, 0.979 ± 0.253 g/ml, 1.058 ± 0.635 g/ml, 0.996 ± 0.284 g/ml and 0.9768 ± 0.244 g/ml in patients with BMI categories 25–29.99, 30–34.99, 35–39.99 and ≥40 kg/m2, respectively. Conclusions Our study demonstrates a non-linear (inverse U-shape) relationship between increasing BMI class and concentricity index, reaching its maximum at a BMI of 30–34.99 kg/m2. Further increase in BMI results in LV dilation.

Metabolic surgery in patients with poorly controlled type 2 diabetes and low BMI Abstract. Bariatric surgery has been established as an efficient therapy for morbid obesity. Metabolic surgery represents the operative treatment of type 2 diabetes and other metabolic disorders. Metabolic surgery does not focus on weight loss, as many mechanisms, which are responsible for the improvement of the glycemic control are independent from weight loss. There are many studies, which show the efficient effect of metabolic surgery in diabetic patients with class II obesity. Furthermore, there is growing evidence, that metabolic surgery does also work in patients with a BMI below 35 kg / m2. Multiple surgical and endocrinological associations have endorsed these facts and adopted their guidelines. In obese type 2 diabetics with a BMI below 35 kg / m2 and a poor glycemic control metabolic surgery should be considered as a therapeutic option.

La obesidad es la alteración nutricia más común en el mundo, el exceso de grasa corporal es una condición preocupante debido a que representa un factor de riesgo que incrementa la morbilidad y la mortalidad. Después de haber sido considerada durante largo tiempo como un signo de buena salud e incluso como un índice de bienestar económico y social, la obesidad se contempla actualmente en su verdadero aspecto, es decir, como causa principal de diversas patologías, tanto metabólicas (diabetes, hiperlipidemias, etc.) como motoras (artrosis, trastornos circulatorios, etc.), sin olvidar la gran relación existente entre la obesidad y algunos trastornos psíquicos. Sin embargo, la publicidad que nos invade incita a comer golosinas y otros productos que pueden contribuir al aumento de peso. Además, los anuncios publicitarios de productos alimenticios suelen estar hechos por modelos de figura muy estilizada, lo que no deja de ser una paradoja (las modelos profesionales suelen seguir dietas de adelgazamiento a veces extremadamente estrictas y perjudiciales). Por todo ello, la obesidad es un problema de gran actualidad que, en los países industrializados, debido a su alta frecuencia, preocupa tanto al personal sanitario como a sociólogos, antropólogos y profesionales de la educación física. El presente trabajo tiene como objetivo principal el poder influir para disminuir significativamente el problema de obesidad en personal adultas mediante un programa de acondicionamiento físico. La obesidad forma parte del síndrome metabólico siendo un factor de riesgo conocido, es decir predispone, para varias enfermedades, particularmente enfermedades cardiovasculares, diabetes mellitus tipo 2, apnea del sueño, ictus, osteoartritis, así como a algunas formas de cáncer, padecimientos dermatológicos y gastrointestinales.[3][4]En forma práctica, la obesidad puede ser diagnosticada típicamente en términos de salud midiendo el índice de masa corporal (IMC), pero también en términos de su distribución de la grasa a través de la circunferencia de la cintura o la medida del índice cintura cadera. Además, la presencia de obesidad necesita ser considerada en el contexto de otros factores de riesgo y comorbilidades asociadas (otras condiciones médicas que podrían influir en el riesgo de complicaciones).[3]El índice de masa corporal es un método simple y ampliamente usado para estimar la proporción de grasa corporal.[6]El IMC fue desarrollado por el estadístico y antropometrista belga Adolphe Quetelet.[7] Este es calculado dividiendo el peso del sujeto (en kilogramos) por el cuadrado de su altura (en metros), por lo tanto es expresado en kg / m².La OMS (Organización Mundial de la Salud) establece una definición comúnmente en uso con los siguientes valores, acordados en 1997, publicados en 2000 y ajustados en el 2010[9]:IMC menos de 18,5 es por debajo del peso normal, IMC de 18,5-24,9 es peso normal, IMC de 25,0-29,9 es sobrepeso, IMC de 30,0-34,9 es obesidad clase I,IMC de 35,0-39,9 es obesidad clase II,IMC de 40,0 o mayor es obesidad clase III, grave (o mórbida),IMC de 35,0 o mayor en la presencia de al menos una u otra morbilidad significativa es también clasificada por algunas personas como obesidad mórbida.

Background: The increased number of patients suffer from diabesity provoke the scientific researchers to deal with its complications either acute or chronic as well as increasing the debate about the effect of aerobic exercises with intermittent fasting 16/8 protocol in modulating this issue.Aim of Study: The current study aimed to determine the effect of aerobic exercise on metabolic profile in diabesity patients under intermittent fasting16/8 protocol.Material and Methods: Forty women diabesity patients with mean age 40.2±2.98 years old. They are diabetic since 5-7 years with class II obesity according to their Body Mass Index (BMI) classification and were assigned randomly using the sealed envelope method of randomization into two groups equal in number. Both groups were under controlled diet regimen with the protocol of intermittent fasting 16/8. GroupA performed treadmill aerobic exercise for 3 times/week during the fasting period (window) with intensity of 40-60% of the Maximum Heart Rate (MHR) for 12 weeks & GroupB performed treadmill aerobic exercise for 3 times/week during the eating period (window). According to training intensity with 40-60% of maximum heart rate for 12 weeks participated in the study BMI, Glycosylated hemoglobin (HbA1c) and 6 minute walk test were used for assessment at baseline and after 12 weeks of training.Results: The results revealed that there was significant reduction of BMI in Group A (9.19%) and Group B (7.12%), and in HbA1c Group A (20.7%) and Group B (13.91%) and significant increase of 6 MWT in Group A (23.8%) and Group B (18.36%) in compare to pre-treatment in both groups. Unpaired t-test revealed that there was significant difference of the mean values of the "post" test between both groups in HbA1c and 6 MWT. This significant difference in favor to Group A than Group B. There was no statistical difference between both groups of the mean values of the "post" test in BMI.Conclusion: Intermittent fasting 16/8 protocol with con-trolled diet regimen and treadmill aerobic exercise for 3 times/ week during the fasting period is the best way to decrease body weight, controlling blood glucose and enhance functional performance in diabesity women.

Objective: The study aimed to assess the prevalence and correlates of underweight and overweight or obesity among women in India. Subjects and methods: In a population-based cross-sectional 2015-2016 National Family Health Survey, ever married non-pregnant women (18-49 years) were interviewed and assessed with anthropometric, blood pressure and biochemical measures. Results: The total sample included 5,82,320 non-pregnant women 18-49 years, median age 31 years, interquartile range =16 years, from India. Overall, 20.1% of the women were underweight [body mass index (BMI)

Background In the multidisciplinary treatment of obesity, the role of a plastic surgeon is to remove the excess of skin after weight loss to obtain cosmetic, functional, and psychological benefits. Obesity modifies body geometry, increases the mass of different segments, and imposes functional limitations in life activities that may predispose the obese to injury. The authors evaluated the postural conditions of obese patients, before and 12 months after surgery. Methods The study included 15 obese patients of both genders affected by class II obesity. Postural function was evaluated preoperatively and 12 months postoperatively. Patients underwent conventional abdominoplasty surgical procedure. In all patients, plantar pressure distribution and balance (stabilometric test) were evaluated before and 3 months after surgery. Results The static pedobarographic revealed a significant reduction in forefoot peak pressure; total plantar force; rearfoot plantar force percentage; midfoot plantar force percentage; and forefoot, midfoot, and rearfoot plantar contact areas percentage 3 months after surgery; the dynamic's one showed a reduction in the first metatarsal peak pressure and plantar contact. The stabilometric values showed a reduction in the range of center of foot pressure (CP) displacement along y axis, the average displacement of the CP speed from the mean (RMS y velocity), and CP mean peak in the condition of vision. Conclusions Our study demonstrates the beneficial effect of dermolipectomies and the consequential weight loss on postural stability of obese men. Such findings may support the hypothesis that dermolipectomy may improve postural stability with and without vision. The data demonstrate that the benefits are related to the magnitude of the resected tissue.

It has been acknowledged that excess body weight increases the risk of colorectal cancer (CRC), however, there is little evidence on the impact of body mass index (BMI) on CRC patients’ long-term oncologic results in Asian populations. We studied the influence of BMI on overall survival (OS), disease-free survival (DFS), and CRC-specific survival rates in CRC patients from the administrative claims datasets of Taiwan using the Kaplan–Meier survival curves and the log-rank test to estimate the statistical differences among BMI groups. Underweight patients (&lt, 18.50 kg/m2) presented higher mortality (56.40%) and recurrence (5.34%) rates. Besides this, they had worse OS (aHR:1.61, 95% CI: 1.53–1.70, p-value: &lt, 0.0001) and CRC-specific survival (aHR:1.52, 95% CI: 1.43–1.62, 0.0001) rates compared with those of normal weight patients (18.50–24.99 kg/m2). On the contrary, CRC patients belonging to the overweight (25.00–29.99 kg/m2), class I obesity (30.00–34.99 kg/m2), and class II obesity (≥35.00 kg/m2) categories had better OS, DFS, and CRC-specific survival rates in the analysis than the patients in the normal weight category. Overweight patients consistently had the lowest mortality rate after a CRC diagnosis. The associations with being underweight may reflect a reverse causation. CRC patients should maintain a long-term healthy body weight.

Objective In the United States, Black and Hispanic patients have a higher prevalence of obesity than Whites (49.6 vs. 44.8 vs. 42.2%, respectively). Despite higher rates of obesity among minority populations, bariatric surgery is performed at higher obesity levels in minorities than in Whites. This study examines the effects of various socioeconomic factors such as race, payer type, and income on the likelihood of undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) at class II versus class III obesity and their associated complications. Materials and Methods National Inpatient Sample (NIS) from 2016 to 2017 was queried to identify patients at least 18 years of age with a concomitant diagnosis of class II or class III obesity who underwent LRYGB. We analyzed obesity level at the time of LRYGB (class II vs. class III), postoperative intestinal obstruction during the admission, and occurrence of any noninfectious complication related to the surgery as our main outcomes. A multivariate logistic regression model was utilized to assess the association between our outcomes and socioeconomic factors associated with the admission. Results A total of 76,405 LRYGB operations were included. Out of this total, 83% (63,640) LRYGB operations were in class III obesity. Black patients had a lower rate (11.6%) of LRYGB procedures at class II obesity than White (17.6%) and Hispanic (18%) patients (p Conclusion Socioeconomic disparities in the surgical management of severe obesity persist in the United States, especially for LRYGB. This study highlights multiple demographic factors that led to LRYGB at later obesity levels. Black patients were also more likely to be associated with postoperative complications during the admission. The determinants of health disparities in obese patients need to be examined further to reduce potential long-term morbidity and mortality in minorities. Further research is also required to identify the adverse effects of health disparities in patients with severe obesity and obesity-related comorbidities.

Introduction Although both obesity and coronavirus disease 2019 (COVID-19) independently induce inflammation and thrombosis, the association between obesity class and risk of thrombosis in patients with COVID-19 remains unclear. Methods This retrospective cohort study included consecutive patients hospitalized with COVID-19 at a single institution. Patients were categorized based on obesity class. The main outcomes were venous thromboembolism (VTE) and myocardial injury, a marker of microvascular thrombosis in COVID-19. Adjustments were made for sociodemographic variables, cardiovascular disease risk factors and comorbidities. Results 609 patients with COVID-19 were included. 351 (58%) patients were without obesity, 110 (18%) were patients with class I obesity, 76 (12%) were patients with class II obesity, and 72 (12%) were patients with class III obesity. Patients with class I and III obesity had significantly higher risk-adjusted odds of VTE compared to patients without obesity (OR = 2.54, 95% CI: 1.05–6.14 for class I obesity; and OR = 3.95, 95% CI: 1.40–11.14 for class III obesity). Patients with class III obesity had significantly higher risk-adjusted odds of myocardial injury compared to patients without obesity (OR = 2.15, 95% CI: 1.12–4.12). Both VTE and myocardial injury were significantly associated with greater risk-adjusted odds of mortality. Conclusion This study demonstrates that both macrovascular and microvascular thromboses may contribute to the elevated morbidity and mortality in patients with obesity and COVID-19.

There is little documentation of the distribution of specific health conditions across obesity classes (I, II, III), especially for paediatric populations who are seen for routine care in large United States US healthcare systems. The aim of this study was to assess the odds of presenting ≥2 obesity-related comorbidities as well as assess the overall distribution of these co-morbidities in children by class I/II/III obesity status controlling for key sociodemographic characteristics. This retrospective (2015-2019) electronic health record review analysed 49 276 patients from the Children's Health System of Texas diagnosed with obesity-related health conditions by obesity status (no obesity, class I, II, III). Crude and adjusted logistic regression models examined the association between obesity class and the likelihood of ≥2 comorbidities as primary diagnoses. Patients with class I obesity were 22% more likely (OR 1.22, 95% CI, 1.16, 1.27), patients with class II obesity were almost 50% more likely (OR 1.44, 95% CI, 1.35, 1.53) and those with class III obesity twice as likely (OR 2.04, 95% CI 1.91, 2.18) to be diagnosed with ≥2 comorbidities as primary diagnoses, compared with patients classified with no obesity. Children with obesity, particularly severe obesity, should be monitored closely by paediatricians for possible diagnoses of risk factors that could lead to adult chronic disease.

Background: Relationship between BMI and all-cause mortality in patients with hypertension remains controversial. This study aimed to evaluate the time-varying association between BMI in patients with hypertension and all-cause mortality. Methods: This population-based cohort study included 212,394 Chinese adults with hypertension from 2007 to 2015 and was followed up until death, loss-to-follow-up, or December 31, 2018. According to the World Health Organization criteria for Asians, BMI was categorized into five groups: underweight (BMI < 18.5 kg/m2), normal weight (18.5–22.9 kg/m2), overweight (23–24.9 kg/m2), class I obesity (25–29.9 kg/m2) and class II obesity (BMI ≥ 30 kg/m2). Cox model was used to estimate the time-varying association of BMI on the risk of mortality by including the interaction term between BMI and time using restricted cubic spline. Results: Compared with normal weight, underweight and class II obesity were associated with higher mortality (Hazard ratio [HRs] at 1 and 10 years of follow-up: 1.51 [95% CI: 1.39–1.65], and 1.27 (1.15–1.41) for underweight, respectively; 1.08 (0.96–1.21), and 1.16 (1.03–1.30) for class II obesity, respectively). However, overweight and class I obesity were associated with lower mortality, although the protective effects gradually attenuated over time (HRs at 1 and 10 years of follow-up: 0.85 (0.81–0.90), and 0.96 (0.91–1.02) for overweight, respectively; 0.80 (0.76–0.84), and 1.04 (0.99–1.10) for class I obesity, respectively). Conclusions: We found increased mortality among hypertensive patients with underweight and class II obesity while decreased mortality with overweight and class I obesity was observed during the first 5 years of follow-up. Management efforts for hypertension may target controlling body weight in a reasonable range for patients, and probably more attention should be given to underweight patients.

Despite worldwide public attention and intense medical efforts, the prevalence of severe morbid obesity in children and adolescents is still rising. Similar to adults, excess adipose tissue triggers multiple immunological and metabolic pathways leading to serious co-morbidities such as impaired glucose tolerance or even type 2 diabetes (T2D), dyslipidemia, arterial hypertension, non-alcoholic fatty liver disease, and hyperuricemia. The management of severe childhood obesity requires a life-long multidisciplinary approach with a combination of lifestyle changes, nutrition, and medications. Standardized life-style intervention programs remain the first-line treatment for morbid obese children and adolescents, but unfortunately reveal limited long-term success. In such cases, metabolic bariatric surgery (MBS) has evolved from being a controversial issue to being included in distinct recommendations. According to the American Society for Metabolic and Bariatric Surgery (ASMBS) Pediatric Committee, indications for bariatric surgery in adolescence must follow very strict criteria. Adolescents with class II obesity (BMI > 120% of the 95th percentile) and a diagnosed co-morbidity or with class III obesity (BMI ≥ 140% of the 95th percentile) should be considered for MBS. These interventions represent high-risk operations, and adolescents should be treated in specialized, multidisciplinary high-volume obesity centers with long-term follow-up programs. The Roux-en-Y gastric bypass (RYGB) remains the gold standard of all malabsorptive procedures. Laparoscopic sleeve gastrectomy (LSG), which the authors pioneered as a stand-alone procedure in morbidly obese adolescents in 2008, has become the most commonly performed operation in morbidly obese adolescents at present. Recent literature proves that MBS is safe and effective in morbidly obese adolescents. Mid-term data have revealed significant improvement or even resolution of major co-morbidities. Thus, MBS for the treatment of morbidly obese adolescents has evolved from being a controversial issue to being included in distinct recommendations by several medical societies as a therapeutic strategy to reduce severe co-morbidities potentially causing end-organ damage in adulthood.

Obesity is a major health problem in Poland and around the world. Excessive gain in early childhood is an important risk factor for the development of obesity. The aim of the study was to analyze the prevalence of obesity in 2-, 4- and 6-year-old obese children.The study group: 656 overweight and obese children aged 5-18 years old. The patients' height and weight were measured, body mass index (BMI) was calculated. Overweight: BMI between 85th-97th percentile and obesity: BMI 97th were defined using World Health Organization. BMI +2 SDS as overweight, BMI ≥ +2 SDS as class I obesity, and BMI ≥ 3 SDS as class II. Measurements from the health books of children aged 2 (n = 626), 4 (n = 533) and 6 (n = 518) years old were analyzed.Mean age: 12.25 ±2.90 years, BMI SDS: +2.54 ±0.60. There were 100 overweight (15.2%) and 556 obese (84.8%) children in the group, including 143 patients with class II obesity (21.8%). Children 10 years old comprised 28%. It was established that 36.6% of the patients were overweight or obese at the age of 2 years old. At the age of 4, the percentage was 73.9%, and at the age of 6, it was as high as 84%.1. The children studied had excess body weight from early childhood. The prevalence of obesity increased with age. 2. Systematic monitoring of developmental parameters in children is essential from an early age.Otyłość w Polsce i na świecie jest istotnym problemem zdrowotnym. Nadmierny przyrost masy ciała we wczesnym dzieciństwie to ważny czynnik ryzyka rozwoju otyłości. Cel pracy: Analiza występowania nadmiernej masy ciała w wieku 2, 4 i 6 lat u dzieci z otyłością.Grupa badana to 656 dzieci w wieku 5–18 lat z nadwagą i otyłością. U pacjentów mierzono wysokość, masę ciała i wyliczono wskaźnik masy ciała (body mass index – BMI). Nadwagę (BMI powyżej 85.–97. centyla) i otyłość: (BMI 97. centyla) definiowano wg norm Światowej Organizacji Zdrowia. Za nadwagę przyjęto BMI +2 SDS, za otyłość I° BMI ≥ +2, za otyłość II° BMI ≥ 3. Analizowano pomiary z książeczek zdrowia dzieci w wieku 2 (n = 626), 4 (n = 533) i 6 (n = 518) lat.Średni wiek pacjentów wynosił 12,25 ±2,90 roku, BMI w SDS: +2,54 ±0,60. W grupie było 100 dzieci z nadwagą (15,2%) i 556 z otyłością (84,8%), u 143 pacjentów (21,8%) występowała otyłość II stopnia. Dzieci 10 lat stanowiły 28% grupy. Stwierdzono, że w wieku 2 lat nadwagę lub otyłość miało 36,6% pacjentów. W wieku 4 lat odsetek wynosił 73,9%, w wieku 6 lat już 84%.1. U badanych dzieci nadmierna masa ciała występowała od wczesnego dzieciństwa. Częstość otyłości wzrastała z wiekiem. 2. Niezbędne jest systematyczne monitorowanie parametrów rozwojowych u dzieci od najmłodszych lat.

Extreme body mass index (BMI) values (i.e., above the 97th and below the 3rd percentiles) are inaccurately represented on the Centers for Disease Control and Prevention’s growth curves, which may limit the utility of BMI percentile and BMI z-score for capturing changes in clinical outcomes for patients at extreme weights. Modeling child obesity severity based upon the percentage of BMI in excess of the 95th percentile (BMI95pct) has been proposed as an improved metric to better capture variability in weight at extreme ends of growth curves, which may improve our understanding of relationships between weight status and changes in clinical outcomes. However, few studies have evaluated whether the use of BMI95pct would refine our understanding of differences in clinical psychosocial constructs compared to previous methods for categorization. This cross-sectional study evaluated child obesity severity based on BMI95pct to examine potential group differences in a validated, obesity-specific measure of Health-Related Quality of Life (HRQoL). Four hundred and sixty-five children with obesity completed Sizing Me Up, a self-report measure of HRQoL. Children were classified into categories based on BMI95pct (i.e., class I: ≥100% and &lt, 120%, class II: ≥120% and &lt, 140%, class III: ≥140%). The results indicate that children with class III obesity reported lower HRQoL than children with class I and class II obesity, however, there were no differences between Class II and Class I. In much of the previous literature, children with class II and class III obesity are often combined under the category “Severe Obesity” based upon BMI above the 99th percentile. This study suggests that grouping children from various classes together would neglect to capture critical differences in HRQoL. Future research including children with severe obesity should consider obesity classes to best account for functioning and clinical outcomes.

Background Obesity in Saudi Arabia is on the rise, especially among females who are more likely to suffer from obesity in the reproductive age group than males in the adult age group. Biologically, pregnancy can increase women’s weight and put them at greater risk for adverse obstetric outcomes. Objectives To find the prevalence of obesity among pregnant women and their obstetric outcomes. Methods This retrospective study was conducted on pregnant women who delivered between January 2013 and May 2018 at the obstetrics clinic of King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. A datasheet was formed to collect data from the medical records of these pregnant women. The analysis was done using the Statistical Package for Social Sciences (SPSS), version 26 (IBM SPSS Statistics, Armonk, NY). A p-value of < 0.05 was used to calculate statistical significance. Results A total of 9,095 pregnant women delivered during that period. Of those women, a total of 2,235 were found to be obese, and 1,842 were included in the study. A total of 1,130 women were categorized under Class I obesity, 458 were categorized under Class II obesity, and 254 were categorized under Class III obesity. The majority of the sample were Saudis (72.3%) and young adults (90.8%) with 1,672 cases. The average age was 31.7 (standard deviation (SD): 5.9). Twenty percent of the sample had preterm newborns, while the majority (62.4%) ended up with cesarean delivery. Advanced age, multipara, and cesarean delivery were statistically significant with adverse pregnancy outcomes (p < 0.05). Conclusion As demonstrated in this study, obesity among females in Saudi Arabia has increased over the past decade. Hence, this puts them at higher risk of developing adverse pregnancy outcomes, as pregnancy physiologically results in additional weight gain. Proper antenatal counseling, health education, and a comprehensive plan prior to conception are highly recommended.

Objectives: Sentinel lymph node (SLN) mapping has become the preferred method for surgical staging of endometrial cancer; however, previous studies on SLN mapping have not reported detection rates specifically in terms of obesity class. Our objective was to evaluate the success of SLN detection in endometrial cancer as it relates to body mass index (BMI). Methods: Clinicopathologic data were abstracted for patients who completed surgical staging at a single institution between 2015 and 2020. All patients who completed sentinel lymph node mapping had cervical injection with ICG green and near infrared imaging via the robotic platform. Descriptive statistics were calculated, chi-square tests were used to assess the associations between categorical variables, and independent T tests were used for continuous variables. Results: A total of 337 patients completed surgical staging over the study period. Of these, 226 women completed cervical dye injection with attempted sentinel lymph node mapping. Two hundred and ten women (92.9%) women had at least a unilateral sentinel lymph node detected with 156 women (74.3%) mapping bilaterally. The majority of patients were obese, accounting for 65% of the study population with a mean BMI of 34.4 kg/m2 (range 18.5 - 66.1kg/m2). Mean BMI at the time of surgery was significantly lower for patients with sentinel lymph nodes identified compared to those who did not successfully map correlating with class I versus class II obesity (34.1kg/m2 vs 39.2kg/m2, p=.02). Only two normal weight or overweight patients (2.6%) did not successfully map, while 28.5% of women with super morbid obesity (BMI>50kg/m2) did not map successfully. Of the super morbidly obese patients that mapped, only 3/7 (57.1%) mapped bilaterally. Patients that did not map had significantly longer procedure time by 35 minutes (192 vs 157 minutes, p Download : Download high-res image (147KB) Download : Download full-size image Conclusions: Patients with failed sentinel lymph node identification had a higher mean BMI and longer procedure time, with the highest rates of failed mapping found in super morbidly obese patients. The current results may aide in the selection of surgical staging methods and the preoperative counseling for patients, particularly those with BMI >50kg/m2.

This study aimed to evaluate whether excessive body weight and the COVID-19 pandemic affect depression, and subsequently whether depression, excessive body weight, and the COVID-19 pandemic affect the course of pregnancy, as well as the well-being of a newborn. The research material included data retrieved from the medical records of 280 pregnant women who were provided with care by medical facilities in Lublin (100 women with normal weight, 100 overweight women, 50 with Class I and 30 with Class II obesity). They completed a Beck depression inventory (BDI) in pregnancy twice, in order to assess the risk of occurrence of postpartum depression. Pre-pregnancy BMI positively correlated with the severity of depression, both at 10–13 weeks of pregnancy (p &lt, 0.001), and at 32 weeks of pregnancy (p &lt, 0.001). The higher the pre-pregnancy BMI, on average the higher the severity of depression. The severity of depression was significantly higher during the pandemic than before it in women with normal body weight before pregnancy (p &lt, 0.001), as well as in those overweight (p &lt, 0.001) and with Class II obesity (p = 0.015). Excessive body weight before pregnancy leads to depressive disorders during pregnancy, increases the risk of preterm delivery, and exerts a negative effect on the state of a newborn. Depressive symptoms among pregnant, overweight and obese women intensified during the COVID-19 pandemic.

Background: : Studies examining the relationship between obesity and female-specific cancers have been mainly conducted in Western populations. We aimed to investigate the risk of female-specific cancers according to obesity and menopausal status using a nationwide cohort in Korea. Methods: : We identified 2,708,938 women from the National Health Insurance Service cohort, and obtained baseline body mass index (BMI), waist circumference (WC), and other healthcare data, measured and collected during a health examinations and cancer-screening survey. By setting a normal weight/WC group (BMI, 18•5–22•9 kg/m2 or WC, 80•0–84•9 cm) as the reference, we conducted multivariate analyses using the Cox proportional hazard model to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CIs) for each cancer. Findings: : The total follow-up duration was 22389854•63 person-years. In post-menopausal women, the risk of breast, endometrial, and ovarian cancers significantly increased as the BMI classification level increased from normal to class II obesity (aHRs [95% CIs], 1•49 [1•38–1.61], 2•11 [1•81–2•46], and 1•38 [1•20–1•58], respectively). The risk of breast and endometrial cancers also increased as the WC classification increased from < 75•0 to ≥ 95•0 cm. With a WC of 80•0–84•9 cm as the reference, the lowest risk of breast and endometrial cancers was observed in WC < 75•0 cm (aHRs [95% CIs], 0•85 [0•81–0•89] and 0•75 [0•67–0•84], respectively) while the highest risk was observed in WC ≥ 95•0 cm (aHRs [95% CIs], 1•19 [1•10–1•29] and 1•56 [1•33–1•82], respectively). In pre-menopausal women, the risk of breast cancer significantly decreased in those with class I and II obesity compared to those with normal BMI (aHRs [95% CIs], 0•96 [0•92–0•999] and 0•89 [0•81–0•97], respectively), whereas the trends of endometrial and ovarian cancer incidence in pre-menopausal women were similar to those observed in post-menopausal women. For cervical cancer, only class II obesity was significantly associated with increased risks in both post-menopausal and pre-menopausal women (aHRs [95% CIs], 1•18 [1•01–1•39] and 1•27 [1•02–1•57], respectively). Interpretation: : In this large population-based cohort study in Korean women, we observed that the impact of obesity on the development of female-specific cancers differs according to the malignancy type and menopausal status. Similar trends were observed between Korean and Western women. Funding: : The Korea Health Industry Development Institute (no. HI16C2037).

Background Obesity is a risk factor for ventral hernia development and affects up to 60% of patients undergoing ventral hernia repair. It is also associated with a higher rate of surgical site occurrences and an increased risk of recurrence after ventral hernia repair, but data is lacking on the differences between obesity classes. Methods Between 2008 and 2018, 322 patients with obesity underwent laparoscopic ventral hernia repair in our department: class I n = 231 (72%), II n = 55 (17%), III n = 36 (11%). We compared short and long-term outcomes between the three classes. Results Patients with class III obesity had a longer median length of hospital stay compared to I and II (5 days versus 4 days in the other groups, p = 0.0006), but without differences in postoperative complications or surgical site occurrences. After a median follow up of 49 months, there were no significant differences in the incidence of seroma, recurrence, chronic pain, pseudorecurrence and port-site hernia. At multivariate analysis, risk factors for recurrence were presence of a lateral defect and previous hernia repair; risk factors for seroma were immunosuppression, defect > 15 cm and more than one previous hernia repair; the only risk factor for postoperative complications was chronic obstructive pulmonary disease. Conclusion Class III obesity is associated with longer length of hospital stay after laparoscopic ventral hernia repair, but without differences in postoperative complications and long-term outcomes compared with class I and class II obesity.

BACKGROUND Inclusion of BMI as criterion in the determination of heart transplant candidacy in children is a clinical and ethical challenge. Childhood obesity is increasing and children with heart disease are not spared. Currently, many adult heart transplant centers consider class II obesity and higher (BMI > 35 kg/m2 ) to be a relative contraindication for transplantation due to risk of poor outcome after transplant. No national guidelines exist regarding consideration of BMI in pediatric heart transplant and outcomes data are limited. This leaves decisions about transplant candidacy in obese pediatric patients to individual institutions or on a case-by-case basis, allowing for bias and inequity. METHODS We review (a) the prevalence of childhood obesity, including among heart transplant candidates, (b) the lack of existing BMI guidelines, and (c) relevant literature on BMI and pediatric heart transplant outcomes. We discuss the ethical considerations of using obesity as a criterion using the principles of utility, justice, and respect for persons. RESULTS Existing transplant outcomes data do not show that obese children have different or poor enough outcomes compared to non-obese children to warrant exclusion. Moreover, obesity in the United States is unequally distributed by race and socioeconomic status. Children already suffering from health disparities are therefore doubly penalized if obesity denies them access to life-saving transplant. CONCLUSION Insufficient data exist to support using any BMI cutoff as an absolute contraindication for heart transplant in children. Attention should be paid to health equity issues when considering excluding a patient for transplant based on obesity.

Noncommunicable diseases (NCDs) associated with obesity generally require drug treatment. The use of medications in individuals with obesity has not been extensively investigated. The objective of this study was to analyze the relation between obesity and medication use. Data from the Brazilian National Health Survey 2013 was used, including 59,402 individuals. Weight and height measures were used to calculate body mass index (BMI) and categorized individuals according to BMI classification (exposure). The number of medications used for treating nine obesity-related NCDs was the outcome variable. Multinomial regression analyses were performed. The risk of use of medications to treat at least one NCD increased progressively with rising BMI, where this risk was even higher for treating two or more diseases. The risk of having to treat two or more NCDs with medications was approximately 70% greater among individuals with overweight (adjusted RR = 1.66; 95%CI 1.46–1.89), 170% greater in those with class I obesity (adjusted RR = 2.68; 95%CI 2.29–3.12), 340% greater for class II obesity (adjusted RR = 4.44; 95%CI 3.54–5.56) and 450% greater among individuals with class III obesity (adjusted RR = 5.53; 95%CI 3.81–8.02), compared with normal-weight subjects. Obesity was directly associated with drug utilization and the number of medications used to treat obesity-related NCDs.

Background: evidence indicates a role of vitamin A in the regulation of fat mass influencing obesity and cardiovascular diseases. Material and methods: a cross-sectional study in 200 women, paired by age and by the recommended dietary intake of vitamin A. Subjects were divided into four groups according to body mass index (BMI): 80 eutrophic (E), 40 overweight (OW), 40 class I obesity (OI) and 40 class II obesity (OII). Lipid and glycemic profiles were measured and oxidative stress was evaluated through serum concentrations of uric acid, glutathione peroxidase (GSH-Px), and thiobarbituric acid reactive substances (TBARS). Results: the cutoff points for deficiency of serum retinol and β-carotene levels were1.05 µmol/L and 40 µg/dL, respectively. For the recommended dietary intake of vitamin A it was 700 µg/day. Retinol and β-carotene deficiency was found in the E group at 5 % and 15 %, respectively, reaching 77.5 % and 82.5 % in the OII group. Conclusions: a correlation was observed between serum concentrations of retinol and β-carotene and glycemic, lipid, and markers of oxidative stress profiles in the groups studied. It was observed that OI and OII subjects who had retinol and β-carotene deficiency presented a risk that was 16 and 20.7 times greater, respectively, of having a diagnosis with DM2 as compared to E subjects with adequate concentrations of vitamin A. Increased demand of vitamin A may be related to increased BMI, body adiposity, and oxidative stress even when a recommended intake of vitamin A is reached.Introducción: la evidencia indica un papel de la vitamina A en la regulación de la masa grasa que influye en la obesidad y las enfermedades cardiovasculares. Material y métodos: estudio transversal con 200 mujeres emparejadas por edad y por la ingesta dietética de vitamina A recomendada. Se dividieron en cuatro grupos según el índice de masa corporal (IMC): 80 eutróficas (E), 40 con sobrepeso (OW), 40 con obesidad de clase I (OI) y 40 con obesidad de clase II (OII). Se midieron los perfiles lipídicos y glucémicos y se evaluó el estrés oxidativo a través de las concentraciones séricas de ácido úrico, glutatión-peroxidasa (GSH-Px) y sustancias reactivas del ácido tiobarbitúrico (TBARS). Resultados: los puntos de corte para la deficiencia de las concentraciones séricas de retinol y caroteno fueron de 1,05 µmol/L y 40 g/dL, respectivamente. Para la ingesta dietética recomendada de vitamina A fue de 700 g/día. Se encontró deficiencia de retinol y caroteno en el grupo E, del 5 % y 15 %, respectivamente, alcanzando un 77,5 % y 82,5 % en el grupo OII. Conclusiones: se observó correlación entre las concentraciones séricas de retinol y caroteno y los perfiles glucémico, lipídico y de marcadores de perfiles de estrés oxidativo en los grupos estudiados. Se observó que los sujetos con OI y OII que tenían deficiencia de retinol y caroteno presentaban un riesgo 16 y 20,7 veces mayor, respectivamente, de ser diagnosticados de DM2 en comparación con los E con concentraciones adecuadas de vitamina A. El aumento de la demanda de vitamina A puede estar relacionado con el aumento del IMC, la adiposidad corporal y el estrés oxidativo, incluso cuando se alcanza la ingesta recomendada de vitamina A.

Background Obesity has long been considered a risk factor for postoperative adverse events in surgery. We sought to study the impact of body mass index (BMI) on the clinical outcomes of the high-risk emergency general surgery (EGS) elderly patients. Methods All EGS ≥65 years old patients in the 2007-2016 ACS-NSQIP database, identified using the variables ‘emergency’ and ‘surgspec,’ were included. Patients were classified into five groups: normal weight: BMI Results A total of 78,704 patients were included, of which 26,011 were overweight (33.1%), 13,897 (17.6%) had Class I obesity, 5904 (7.5%) had Class II obesity, and 4490 (5.7%) had Class III obesity. On multivariable analyses, compared to the nonobese, patients who are overweight or with Class I-III obesity paradoxically had a lower risk of mortality, bleeding requiring transfusion, pneumonia, stroke and myocardial infarction (MI). Additionally, the incidence of MI and stroke decreased in a stepwise fashion as BMI progressed from overweight to severely obese (MI: OR: 0.84 [0.73-0.95], OR: 0.73 [0.62-0.86], OR: 0.66 [0.52-0.83], OR: 0.51 [0.38-0.68]; stroke: OR: 0.80 [0.65-0.99], OR: 0.79 [0.62-1.02], OR: 0.71 [0.50-1.00], OR: 0.43 [0.28-0.68]). Conclusion In our study of elderly EGS patients, overweight and obese patients had a lower risk of mortality, bleeding requiring transfusion, pneumonia, reintubation, stroke, and MI. Further studies are needed to confirm and investigate the obesity paradox in this patient population.

OBJECTIVE To evaluate the association of increasing body mass index (BMI) on postpartum tubal ligation safety and estimate the rates of procedure complication. METHODS We conducted a single-institution, retrospective review. Women undergoing postpartum permanent contraception after vaginal delivery from August 2015 to March 2019 were studied. Our primary outcome included a composite morbidity of intraoperative complications (bleeding requiring additional surgery, and extension of incision), blood transfusion, aborted procedure, anesthetic complication, readmission, wound infection, venous thromboembolism, ileus or small bowel obstruction, incomplete transection, and subsequent pregnancy. Statistical analysis included t test, χ test, and Wilcoxon rank-sum test, with P

Introduction In a nationwide population of adolescents, we investigated the sex-specific association of socioeconomic position (SEP) with severe obesity, and trends over time. Methods The cohort comprises all Israeli adolescents (mean ± SD age 17.3 ± 0.5 years) who were medically examined, before mandatory military service during 2000 to 2015. Of 1 120 362 adolescents, 239 816 (21.4%) were classified with overweight or with obesity classes I to III using the International Obesity Task Force criteria. Data were compared between 2000 to 2009 and 2010 to 2015. Results Considering more advantaged residential SEP as the reference group, the respective odds ratios (ORs ± 95%CI) of less advantaged SEP for obesity classes I to III in 2010 to 2015 were 1.48 (1.40-1.56), 1.66 (1.51-1.83), and 1.73 (1.45-2.08) for males; and 1.72 (1.60-1.84), 1.89 (1.66-2.15), and 2.62 (2.04-3.37) for females. All point estimates were higher than in the preceding decade. Considering female inductees from the more advantaged SEP as the reference group, ORs were higher for males in the more advantaged SEP group, for overweight, 1.31 (1.27-1.36); class I obesity, 1.29 (1.20-1.38); class II obesity, 1.34 (1.18-1.53); and class III obesity, 1.60 (1.24-2.07). Similarly, in the less and medium advantaged SEP groups, increased ORs for males compared with females were observed in all obesity groups. Results persisted using United States Centers for Disease Control and Prevention growth charts. Conclusions Adolescents with less rather than more advantaged residential SEP are at greater risk of severe obesity. Adolescent males, of all residential SEP groups had higher odds than females for all classes of obesity.

BACKGROUND: Deep venous thrombosis (DVT) and pulmonary embolus (PE) remain an important cause of morbidity and mortality after THA and TKA. Prior recommendations have advocated for more aggressive prophylaxis for patients with obesity, whereas the evidence supporting these recommendations is conflicting and often based on underpowered studies. QUESTIONS/PURPOSES: (1) What is the association between obesity and DVT and PE after primary and revision THA and TKA? (2) Is there a body mass index (BMI) threshold beyond which DVT and PE risk is elevated? METHODS: We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2008 to 2016 to evaluate the reported 30-day rates of DVT, PE, and combined venous thromboembolism (VTE) after primary THA, primary TKA, revision THA, and revision TKA according to BMI as a continuous variable and a categorical variable as defined by the World Health Organization cutoffs for underweight, normal weight, overweight, and obesity. This database is risk-adjusted and designed to capture complications after surgery, thus making it ideal for this study. The diagnosis of DVT and PE is included in the ACS-NSQIP database for any DVT or PE requiring treatment. Proximal versus distal DVT is not specified within the database. Multivariate logistic regression was performed to determine if obesity was independently associated with DVT and PE risk by controlling for age, sex, race, American Society of Anesthesiologists score, diabetes, hypertension, smoking status, general anesthesia, and hypoalbuminemia. RESULTS: After controlling for potential confounding variables such as medical comorbidities and procedure type, patients undergoing primary and revision THA and TKA with World Health Organization classification as underweight (BMI < 18.5 kg/m(2)), overweight (BMI 25-29.9 kg/m(2)), Class I obese (BMI 30-34.9 kg/m(2)), Class II obese (BMI 35-39.9 kg/m(2)), or Class III obese (BMI ≥ 40 kg/m(2)) did not demonstrate an association with increased risk of DVT compared with patients classified as normal weight (BMI 18.5-25 kg/m(2)). Compared with patients undergoing primary THA classified as normal weight, the risk of PE was elevated in patients with Class II obesity (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.23-4.50; p = 0.009) and all heavier categories. Compared with patients undergoing TKA classified as normal weight, the risk of PE was elevated in patients classified as overweight (OR, 1.56; 95% CI, 1.03-2.36; p = 0.035) and all heavier categories. CONCLUSIONS: This large administrative database study suggests that patient classification as overweight or obese is associated with increased risk of development of PE but not DVT after primary THA or TKA. Because aggressive pharmacologic anticoagulation regimens can decrease the DVT rate but have not been shown to affect the rate of PE or death, the data do not currently support increased anticoagulation in patients with obesity without other risk factors for VTE undergoing THA or TKA. Additional studies are required to refine VTE prophylaxis protocols to reduce PE risk while maintaining acceptable postoperative bleeding risk. LEVEL OF EVIDENCE: Level III, therapeutic study.

Background: Both obesity and vitamin D deficiency are pandemics and both have influences on cardiovascular parameters. The reported prevalence of vitamin D deficiency in obesity is high. Data relating to vitamin D status in obese is currently lacking in Bangladesh. Objective: To discover the vitamin D status in Bangladeshi overweight and obese adults. Subjects and Methods: This cross-sectional study, conducted in a specialized endocrine center of Bangladesh, evaluated 500 consecutive overweight or obese subjects, diagnosed according to body mass index (BMI) categories applicable to the south Asian population. Serum 25(OH)D was measured by using the enzyme-linked fluorescent assay (ELFA) method, and the cutoffs described by the Endocrine Society were used to define vitamin D status. Results: The mean age of the study subjects was 45.85 (±11.41) years; most (59.6%) of them were in the age group 40–59 years; almost three-fourth (72.4%) were females; an almost equal number of them came from urban (33.8%), semi-urban (29.6%), and rural (36.6%) areas; three-fourth (74.2%) were homemaker. Their mean BMI was 29.54 (±3.11) kg/m2; the frequencies of overweight, class I obesity, class II obesity, and class III obesity were 27.6%, 57.4%, 12.2%, and 2.8%, respectively. The mean serum 25(OH)D level was 25.25 (±11.97) ng/mL. 27.4% were sufficient, and 33.4% were insufficient for vitamin D, whereas 39.2% had vitamin D deficiency. The 25(OH)D level did not differ across different age groups, gender, residence, education status, occupation, and income status. The 25(OH)D levels were also indifferent in overweight, obese class I, obese class II, and obese class III subjects. None of the demographic, anthropometric, and biochemical variables (except low-density lipoprotein cholesterol) correlated with 25(OH)D levels. Conclusions: The prevalence of vitamin D deficiency in overweight and obese Bangladeshi adults is very high.

Diabetes Mellitus (DM) and obesity are a public health problem in Chile. Bariatric surgery is the most effective treatment alternative to achieve a significant and sustained weight reduction in patients with morbid obesity. The results of controlled clinical trials indicate that, compared to medical treatment, surgery for obese patients with DM2 allows a better control of blood glucose and cardiovascular risk factors, reduces the need for medications and increases the likelihood for remission. Consensus conferences and clinical practice guidelines support bariatric surgery as an option to treat DM2 in Class III Obesity (Body Mass Index (BMI) > 40) regardless of the glycemic control and the complexity of pharmacological treatment and in Class II Obesity (BMI 35-39,9) with inadequate glycemic control despite optimal pharmacological treatment and lifestyle. However, surgical indication for patients with DM2 and BMI between 30-34.9, the most prevalent sub-group, is only suggested. The Chilean Societies of Endocrinology and Diabetes and of Bariatric and Metabolic Surgery decided to generate a consensus regarding the importance of other factors related to DM2 that would allow a better selection of candidates for surgery, particularly when weight does not constitute an indication. Considering the national reality, we also need a statement regarding the selection and characteristics of the surgical procedure as well as the role of the diabetologist in the multidisciplinary team.

The study aimed to assess the prevalence of underweight and overweight or obesity and their sociodemographic, lifestyle, and health factors in a national adult population in Lao People’s Democratic Republic (PDR) (Laos). A national cross-sectional study based on a stratified cluster random sampling was conducted in 2013. The total sample included 2531 individuals 18–64 years, (females = 59.3%; mean age 38.7 years, SD = 12.8) from Laos. Questionnaire interview, blood pressure and anthropometric measurements, and biochemistry tests were conducted. Multinomial logistic regression was utilized to determine the association between sociodemographic, lifestyle and health status factors, and underweight and overweight or obesity relative to normal weight. Using Asian criteria for body mass index (BMI) classification, 9.7% of the population was underweight (BMI

The American Society for Metabolic and Bariatric Surgery Pediatric Committee updated their evidence-based guidelines published in 2012, performing a comprehensive literature search (2009-2017) with 1387 articles and other supporting evidence through February 2018. The significant increase in data supporting the use of metabolic and bariatric surgery (MBS) in adolescents since 2012 strengthens these guidelines from prior reports. Obesity is recognized as a disease; treatment of severe obesity requires a life-long multidisciplinary approach with combinations of lifestyle changes, nutrition, medications, and MBS. We recommend using modern definitions of severe obesity in children with the Centers for Disease Control and Prevention age- and sex-matched growth charts defining class II obesity as 120% of the 95th percentile and class III obesity as 140% of the 95th percentile. Adolescents with class II obesity and a co-morbidity (listed in the guidelines), or with class III obesity should be considered for MBS. Adolescents with cognitive disabilities, a history of mental illness or eating disorders that are treated, immature bone growth, or low Tanner stage should not be denied treatment. MBS is safe and effective in adolescents; given the higher risk of adult obesity that develops in childhood, MBS should not be withheld from adolescents when severe co-morbidities, such as depressed health-related quality of life score, type 2 diabetes, obstructive sleep apnea, and nonalcoholic steatohepatitis exist. Early intervention can reduce the risk of persistent obesity as well as end organ damage from long standing co-morbidities.

Objective The goal of this study was to determine attitudes and practices of physicians in training with respect to the evaluation and treatment of obesity. Methods Resident-generated admission and discharge notes of all 1,765 general medicine hospital admissions during 4 nonconsecutive months were analyzed, and any references to weight, obesity, BMI, adiposity, and body fat were identified. The full general resident cohort was then surveyed for perceptions and behaviors related to obesity. Results Obesity was considered a highly important medical issue by 98.5% of residents; 90% correctly identified a class II obesity Stunkard phenotype, and 80% accurately calculated a BMI given height and weight in metric units. Residents overestimated inpatient obesity prevalence (estimate = 75%; actual = 35%) and the rate of obesity recording in the hospital admission note (estimate = 94%; actual = 49.5%). A BMI or current weight in the admission note or discharge summary was reported in none of the 1,765 patient records, and only 6% of the patients with obesity had obesity noted in either the inpatient admission or discharge assessment or plan. Conclusions Though residents recognize obesity and its clinical implications, it is underreported in the assessment of inpatients. This low level of documenting obesity and its impact on clinical care planning underscores a missed opportunity to establish appropriate referrals and initiate treatment at a clinically opportune time.